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Today on This Week Health.

the New York Yankees sign a 40 million dollar free agent and it doesn't work out. Oh, well, it didn't work out. The Tampa Rays signed a 40 million dollar free agent.

It doesn't work out. That's it for the Tampa Rays for like three years to recover from a contract like that. We're more That smaller team, let's be really smart about what we invest in so that it's not just a technical solution in search of a problem to solve

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Hello, I'm Sue Shade, Principal at Starbridge Advisors, one of the hosts for the Town Hall Show at This Week Health. Today, my guest is Jeff Gottney, Chief Information Officer at Rush University System for Health. Jeff and I first met when we were both working at Ernst Young over 20 years ago.

With his extensive consulting background and now serving as CIO at a leading health system for the past two years, I'm really looking forward to catching up with Jeff and learning more about his current work. Welcome, Jeff.

Thanks, Sue. Really glad to spend some time with you, and it's good to see you again.

Too long.

Likewise. Well, this should be interesting, just hearing what you're up to these days. Let's start by having you briefly introduce yourself and tell us about Rush.

Sure. So my name is Jeff Gottney, as Sue mentioned. I joined Rush just over two years ago now. Prior to that, I was a partner at Ernst Young and a principal at Deloitte, and in between those two stints spent about eight years at Northwell Health responsible for most of the IT operations at Northwell Health, working with their CIO, John Bosco.

So very kind of a varied background, spent some time with vendors. I'm going to show my age now and say that I kind of started my career at SMS shared medical systems back in the day. Also spent some time at Allscripts, the two consulting firms. it. And then was a pretty big operation to run,

we are at our heart 3 hospitals, 2 community hospitals, and 1 large academic medical center. Unlike a lot of other academic medical centers, we're actually, the university is an integrated part, so I'm responsible for the 4 schools that make up our university, as as our patient care and research operations.

I'm, proud to say that we're generally pretty well known for the quality of care that we deliver. In fact, just this week, we were announced to be number two in quality in the country by Vizion, which counts for a lot for us. And that follows through over to IT. We've been recognized in the Honor Roll program with Epic , eight gold stars.

Wanting to get to 10 is really tough, but we're, we're at a most wired, a lot of the other kind of, normal recognition things that we've been able to accomplish as, as an IT department together. So it's 3. 3 billion health system. So it's that sort of. Medium sized health system and our big angle is the quality of the care that we deliver.

Oncology and neurology are two of our leading service lines and where we see an awful lot of investment within Rush. in fact, just this past year, we opened a brand new nine story ambulatory building on our campus. It's focused in on on oncology and we're just about to, in March, open an additional hospital on campus, Rush Specialty Hospital, that'll focus on rehabilitative services.

We're doing that in partnership with SelectHealth. it's also got a long history. There actually was a Rush before there was a \ City of Chicago, so just over 185 years old, and precedes the actual incorporation of the City of Chicago. And as an IT professional, and I'm sure many of you who are listening to this have the same situation, there are parts of the organization that look like they were still the parts that were built 185 years ago, with all the impossible to navigate hard surfaces and, 180 years of cable that have sat on top of one another, all the challenges of an inner city hospital that's got old buildings in some cases, and so, but it's been uh, it's been a great two years.

Excellent. Thanks. That's great introduction. And yeah, I can relate to some of what you're saying, especially the old buildings at some of the places that I've worked. And there are particular challenges when you're looking at cabling and infrastructure that you're trying to put in. So, and, and don't worry about the age thing.

I may have you beat on that when I say how many years I've been in the industry. So I know your first couple years have been pretty intense there at Rush. What are some of the key accomplishments for you and your IT team at this point?

Yeah, I mean, I think I inherited an IT function that had it's like a, a house with really good bones.

Like you look at it and it's not a tear down. But there were a lot of pieces that didn't receive all of the service that they needed to. And you layer on top of that COVID and the priorities, that obviously were shifted there for 18 or 24 months, particularly in how capital and operating was spent as it relates to IT.

We're fortunate in that the leadership team of the health system really recognized that and they've been very generous in investing in IT services over the last two years. So we're entering year three of what I had kind of outlined as a three year remediation plan. And the remediation plan included the things you would expect, like infrastructure.

So we've replaced 8, 000 Windows 7 workstations over the last two years. We've started the recabling of most of our major buildings on the main campus. We've replaced all of our core switches inside the data center. But it also included a real look at expanding our cyber services. So the team I inherited was about maybe 18 or 20 people in our cyber group and today we're at about 40.

So we expanded the service and the specialization and the tools that that cyber team has to use and that pays dividends every day in terms of making it a safer environment. And then the last thing I would say is, the workforce. So, like our workforce, like many others kind of came out of COVID pretty worn out.

And operations, which had kind of had two years of pent up demand, sort of dumped all of that at one time. On the team. The team I inherited didn't have the proper organization structure, didn't have the right staffing levels and we were in the midst of an unintentional shift to a remote workforce, which is meaning to say we moved out, like most people, most IT departments did.

While we moved out, The health system took away about two thirds of our seats, so we weren't able to move back. And so, and so it took some time to figure out how do you engage employees? And then we sort of embraced it. We said, okay, we're going to be remote, then let's be remote. And we expanded our recruiting capabilities.

And I'm pleased to say today that our workforce, which is about 450 people in IT includes leaders from 20 different states. When I mean leaders, I mean like... ABPs and Senior Directors, so it's not just, staff analysts that are actually remote employees. So, we found, I think, a secret sauce to make that work pretty effectively.

And and that's been a big part of the rebuild. Actually, the most essential part of the rebuild has been rebuilding the team. Much more important than the infrastructure. So, this year is meaning to roll over towards applications. So, while we are a health system, we haven't always functioned as a health system.

And we've made independent decisions in many parts of the business. So part of my job was to first regather together and reconstitute an enterprise IT function. So we moved all the shadow IT into one place and we moved it up to the enterprise level within our finance structure. But now we're going back and looking at those application decisions.

So, we have two of everything and three of many things. And we're starting to pound through the process to sort of rationalize that and move to a new enterprise version based on leading practice, not based on any one particular entity's version of that application. So, and that's, that's really what year three the rebuild is really about is starting to rationalize applications and, data centers and all those other pieces and parts.

Okay. That are still very, disintegrated. 📍

  📍

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Got it. That's a great segue into the next question, which I wanted to get into, which is what are your current priorities? And it sounds like application rationalization, though you didn't use that term is part of that. And just looking at like what you said about leading practices as opposed to just, going with one solution from one of the organizations.

And I, and I know when you bring together You have community hospitals with academic medical center. You've got some challenges there in terms of the disparity of those systems. Shadow IT, I can relate to, especially in an academic medical center. So if you've already addressed that, that's excellent. But talk to us a little bit about your current priorities.

Well, cyber always will remain, the number one priority, right? And we have way too many examples, even in our community, where folks who believe that they were pretty well protected. Have still suffered. So I'm, pleased to say that the investments that we've made, the changes we've made in cyber have led directly to a very significant reduction in our cyber insurance premiums.

So, we've gotten more coverage at a significantly less price than we were able to directly related to the changes that we've made. That said, we're shifting a lot from sort of the front end of the CSF framework, the NIST framework, towards the back end. So, less around protect and detect, and more about what's our response, how do we build a team, how do we reinforce our partnerships with other stakeholders.

Solution providers in cyber to really make sure that when something bad happens and something bad almost always happens, we know exactly what our plans are. We know exactly who our partners are. We're ready to jump into action. We have the right resources and we have, the communications networks that can help us be effective.

So, and that, and that's kind of a theme, Sue. there's no easy way to say this other than to say we're trying to build a very nimble team. that can pivot and thinks as business people first and technicians second. And so that's a real culture shift. And in some cases, that's, you know, a lot of investment in our, team to help them understand better the business that they're supporting and why and how the technology and business intersect with one another.

The applications people, it's a little easier for because they're closer to the actual workflow of what's happening. It's a little harder for the cyber and tech people. One of the things we did this year was we added a business information security officer, a BISO, to our security team. So this is a person whose sole job it is, this is sort of translate from all that cyber technology piece.

To how that relates to privacy, security aspects, the ethical aspects, and so her job is really to help Facilitate the communication between, with the cyber organization and the rest of the business. The other thing I would say, priority is, is definitely digital. and AI.

So, I mean, there's probably no podcast you could listen to and AI doesn't come up in some way, and I'll talk about it in other, in other instances as well. But I think, with both digital and AI, it's sort of trying to put in place the structures to honestly assess the value of what we're proposing to do and what the impact is, and to try to make smart decisions.

That are aligned with our priorities, not just chase, shiny objects. We've done a little bit of that in our past. as I'm sure all, every organization has. And in this day and age with resources as tight as they are, you just have a little less slack to be able to make big mistakes.

Than you did before. I always say I'm a baseball fan. So I say we're probably more like the Tampa Rays than we are the New York Yankees. So the New York Yankees sign a 40 million dollar free agent and it doesn't work out. Oh, well, it didn't work out. The Tampa Rays signed a 40 million dollar free agent.

It doesn't work out. That's it for the Tampa Rays for like three years to recover from a contract like that. That's kind of where we are. We're more That smaller team, let's be really smart about what we invest in and let's follow it through so that it's not just a technical solution in search of a problem to solve, but it's driven by the business leaders.

Okay.

So, I wanted to get into, technology and looking ahead keeping your eye on AI, I'm assuming, as part of that. Do you want to say more about how you're trying to address that?

Yeah, we actually, we put in place this structure, and what I wanted to do with AI was I, I wanted to dispel this notion, first off, that it should be something we do separate from everything else we do.

So, I wanted to connect it into existing teams that we have in place. So, we have this kind of four bucket model that we're trying to work through. So the first bucket is how do we vet the value? How do we both look at ideas that people bring to us? Right around how to use ai and by a ai, I'm including R P A, so Robotic process automation.

Mm-hmm. Chat, G B T or generative ai. Mm-hmm. , but also pure ai, the kind that you might see, for instance, in looking at image analysis and cardiology as an example. Right. So looking at the whole universe of what AI solutions might, might be, and we want. Have ideas, be brought in by others.

There's lots of grassroots ideas, but we also want to take a look at what are our, we have seven key strategic priorities for the organization. Seven strategic, business priorities and apply a lens of how can AI or how could AI be applied to the organization. Enable us to improve that. So, this bottom up and top down way of filling the funnel with opportunities to utilize AI and then applying a very formal process towards understanding the value, the risk, the investment that's required to try to prioritize what we should work on.

So that is part of our digital transformation committee, which does that for all digital health initiatives. And we call that our AI incubator. So this is where we're going to take ideas and, figure out which ones we want to work on. And we've got a second team that is focused on how do you do it responsibly and safely?

So we call that our Office for Responsible AI, and it includes representatives from legal and privacy and compliance and cyber and medical ethics and, and those guys look at, okay, here's the idea. Now, how do we make sure we write a contract that actually protects us? I don't know if you've looked at an AI contract lately, but all the responsibility is on us, right?

They basically take no responsibility, even though we don't have the tools to monitor or even understand what they used to train that AI protocol. So, this Office of Responsible AI is meant to translate, from idea to action as it relates to getting a good contract done and making sure we have the safeguards in place.

And we had, data governance group, and so we have made that a part of the data governance group. Since, data is kind of the core engine that feeds all of this AI work. The third group is a group that's focused on the data itself. Mobilizing the data, making sure we have good data, clean data.

If we're partnering with a vendor to develop something on AI, we understand what data set they're going to use. We understand what our extended data sets are, external data that we buy. And that's a group that we already had in place called, it's an awful acronym, but it's called COBRA. And they basically own both research data sets as well as patient care data sets, knowledge management, analytics, and so forth.

And then the fourth group is a tools group. What worried me a lot was everybody going out and buying their own set of tools setting up their own cloud environments and so forth and so on. I don't think that does us any good. So, to the extent that we're going to use different tools, whether it be tools to do true authoring.

of AI because we're a research organization, there's some of that kind of work. Or there are tools that are extensions to existing tools, like using UiPath or Automation Anywhere to do RPA work. There's a tools team that's meant to kind of make good decisions about what those tools are, integrate them, and be able to use them.

So those four groups together are all built off of groups that already existed and now we've brought them together to focus on AI. And that way, we're not trying to build something that's outside of our normal governance structure. We're instead focusing them on this new set of technologies.

And we're trying to make, part of that first group, the incubator group, is also meant to raise the literacy of managers on how to use AI effectively and realistically. What's possible, they've set the bar pretty low, you can download ChatGPT, most, those of us who have children who are in high school or college probably used it to author something.

Somewhere along the way in their schoolwork. And so they've made it look like it's this super easy, simple thing to do. Not the reality, which is it's massive, models of data and fields of GPU computing power. And to really do machine learning is a massive undertaking that most health providers, certainly we can't.

Afford to and don't really want to make that investment. We would much prefer to look at our major vendors, Epic, Workday, ServiceNow, Salesforce, figure out where they're going and try to partner with them to be early adopters of technology and use cases as they So, as an example, one of the things we're doing is partnering with Epic.

They're rolling out a new AI sandbox. Where you can, play with and practice and develop new protocols using your data in a safe environment, and we think that's a, that's a great model for how to add innovation that we drive. So we're driving the protocols, but do it within an environment that creates functions that are already integrated with our pillar applications, already clinician workflow.

One of the things we're concerned about is outside tools. They're great, but how do you integrate them into the workflow? How do you not cause more problems for clinicians in doing that work?

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Awesome answer in terms of what you're doing around AI. I love the four groups, the fact that you're integrating it into existing.

Governance and structures, and so it's not like a one off over here, so very impressive. We, maybe we should talk again and hear some of the results in the future, but it sounds like you've got something you could write up too, just about how you're approaching AI. There are some other things I want to get into that are a little bit more unique in terms of your background and coming into the CIO role. I do want to find out your thoughts in terms of how your very extensive consulting background over the years has helped you, I'm assuming it has, to be effective as you transitioned into the, the CIO role.

Well, I definitely had an advantage in that I took that stint, took those, eight years or so at Northwell. That a lot of my, learning process of what it meant to be in operations versus be a consultant got kind of worked out through that Northwell process. But I've hired many people into my team now that come from consulting backgrounds.

And the positives, I think They bring an analytical view they value planning, which sometimes when you grow up in operations and you realize that, every day that Things change, your plan changes. It's easy to kind of leave planning aside and just be reactive. People with a consulting background tend to value planning, and they recognize that plans have to change, you have to be flexible, but they bring that planning sort of skill set, those muscles to the table, and they're very valuable in an organization like nimble.

I think, a willingness to change models and change perspective and to think outside of the box, bring different solutions. I think what we're doing with remote workforce, while it's not completely unique, I think there are some unique things that we've added to it that I'm really proud of and that I think have made the team much stronger.

And then I also think just a willingness to, and an understanding of the need to engage with customers. And to have customers drive change, and that every change is a transformation of some fashion and requires change management. It's easy when you're a technician and, we are not unlike other IT departments.

We're, in a building, not directly in a lot of patient care areas, so it's easy sometimes to forget. the business you're serving, right? Cause they're not right in front of you all the time, the way it used to be. And so it's really important that my folks spend a good portion of their time, even though they're remote, with their customers and not with just their colleagues or their teams.

And so that's something I think that as a consultant, that's just naturally what I would always want to do. But that's not necessarily what you're doing when you're in operation. So it's been a little bit of a. A learning experience for them. On the flip side, like what I have to, what you have to learn is you also have to learn that all of your plans mean nothing when, at 10 o'clock you get a call and such and such is PC wasn't delivered or there's a major data center outage or Comcast is on the fritz and so half of your remote employees in Chicago are struggling to try to connect using their cell phones and so the operations piece sort of resets your priorities every day.

Also, I think, when you're in consulting, in a lot of ways, your workforce are all type A, and you can offer them unlimited opportunities to do different kinds of projects. And they do the projects, and then the projects end, and so the leadership changes, what they're working on changes all the time.

There's this constant variety. And so it's not all that hard to motivate them, in operations, it's different, right? We have all different levels of folks, who come from all different kinds of backgrounds, and have all different kinds of... views of what their work experience should be.

And we need all of them. And I want all of them. Like, I think that it's really the strength of a team that there's all that kind of variety and not just single mindedness. And there's a different, you take a different perspective if you're building a house that you're going to live in versus just building a house and moving on to build the next one.

And so for us, we're building houses that we have to live in. And so if we screw up the electric or we under. estimated, how much hot water we were going to need for the master bathroom. We have to live with that decision and try to make it better versus a consultant just kind of moves on to the next house and says, oh, I wish we hadn't done that.

Next house we build won't, won't be built like that. So those are the, I think those are really the kind of things that where the consulting background has been helpful, but at times it's also been, a learning curve. And an understanding. in operations, you're always playing the long game. In consulting, you're always playing the opposite.

You're there to do a job. You're on a timeline. You're on a budget. Nine months. You're focused. And the advice I would give to somebody who's trying to sell to me or work with me. From a consulting standpoint is to understand that we hired you because the project is really vitally important.

So we acknowledge that and we acknowledge that we're making a major investment to get the benefit of your expertise, but you also have to understand that that project is one project in a whole pantheon of things we're doing and that operations oftentimes shuffles our priorities. So there's project work we do, but there's also.

The care and feeding of the health system, and that at times, we need your... patience with us to understand that we're doing many times doing the very best we can to provide you everything that you want. And also say, come to us as a partner, like come to us with a mind towards an almost like as a consultant, I need to show you the value I'm delivering every day.

Not just push you through a process, but show me the value that you're delivering every day and help understand what our problems are, what our challenges are beyond just maybe what we're immediately saying to you, why we hired you. I, one of the things I would tell you over the last two years, I inherited a whole bunch of different vendor and professional services relationships.

Many of them were very good. \ and those we've, that were good, we've worked hard to make them better and Be better partners, right? So, we always say partner with us, but usually that means give us a better price, right? Partner is the two way street, and we understand that, and we're trying to become better partners too.

Some of them, turned out, even though they were very big relationships, financial relationships, they really weren't good partnerships. Where folks didn't really... Look at us as anything other than somebody that they could sell products to. And so those are commodity vendors. And it's not that we don't do business with commodity vendors.

It's just that they're treated in a different way. Now they're not inside the tent when we do planning. They're not somebody we consult with to get new ideas from. They're somebody I'd buy from. And if I'm buying from you that way. Then price is the only thing that makes you different and just be ready for that.

Like, be ready that we're going to negotiate and we're going to shop things around and find the best price if you're a commodity vendor versus a partnership. We have fewer partnerships than we had today. I can't manage 100 partnerships. Right. Because I don't get value out of 100 partnerships. So we have fewer and those partnerships, we re evaluate them, but we do it together with the partner each year.

Are you getting the value out of the partnership? Am I getting the value out of the partnership? How can we improve that? And I think that that, giving that care and feeding, it's sort of like having friends, right? You have good friends, but if you don't invest the time and you don't have shared experiences with them, even though sometimes they disappoint you or you disappoint them, there's this friendship and there's this ongoing shared experience that happens that keeps the relationship tight.

In my mind, vendor partnerships aren't any different than that. If you don't invest in them, then they become commodities. and like I said, sometimes that's okay. I don't need a, I guess it's going to sound really awful. I guess I don't really need a hundred friends. Yeah. I really need 20 that are really close friends that'll tell me the truth.

And I can count on when I need them. Right. So that's kind of how our it department looks at it. Excellent.

Excellent.

Well, thank you. You covered the other question that I wanted to get into. In terms of advice to your vendor partners as well as really I think good insight in terms of what your consulting background has done for you in this role.

Is there anything else that you wanna highlight before we close?

Maybe just two other things. number one looking for mentors. So, Sue, you've been a mentor to me, looking for examples in the industry of folks, particularly as we go through these last few years where it's been very difficult, looking at people who are.

Smart and innovative, but also compassionate and focused on the people and the business aspect and the reality of where our business is in the United States. Healthcare providers are in the United States, learning from each other that way and collaborating is really, really important to me. And I've been really blessed to have a number of really Smart people, well rounded people who have been good advisors to me over the years.

so one piece of advice would be to seek that out. And then the one thing I would tell you is, there's tons of doom and gloom out there. So we were one of, I guess what, 80 percent of hospitals lost money last year. We were one of the ones that didn't, but we all know that that's not sustainable.

Like we're, we'll be in the 80, I'm sure. The 80 will probably be 90 this year or higher. And so maintaining high quality and understanding the financial costs of that and the pressures of that is just, a meat grinder for everybody to go through right now. But I believe this is going to be...

The shining moment for technology and for information technology. I think we're better positioned than we've ever been. More data is available to us. More automation is available to us. More tools are available to us. If we can be nimble and we can be engaged in the business, we can make a material difference in what it costs to deliver healthcare in this country and what the patient and the clinician and employee experiences, and I believe people look back on this.

Five years from now and say, my God, how could we, how could we accomplish what we accomplished if IT wasn't in the middle of that? kind of similar probably to where FedEx was 20 years ago with logistics. Like, how are we going to move packages and deliver them overnight? Yeah, we have planes, but oh my God, think about the logistics.

Where is that package? What plane is it on? How does it get to a truck? How does it get? That was all IT. So it went from being like, here's how we're gonna invoice people to, this is the whole business . So I, I think that we're at that moment, I think it's an inflection point for us. I think the cost pressures in the US healthcare system are forcing different models for delivering care.

They're forcing different ways of looking at how to be efficient and be productive, and the tools and technologies that we offer and the talents that our team offer in partnership with our. customers is absolutely essential. And we didn't talk about the university, by the way. But we're also revolutionizing the way, that clinicians are being trained.

I think that that's another big thing. It's an investment because the environment that Dell practice medicine in is very, very different. than, the environments of years past. So I know I've, I, I'm a New Yorker. I tend to talk a lot and talk fast, and I apologize for that. A New Yorker living in Chicago, so it, communications is a challenge sometimes with my team.

They kind of say, slow down or take a breath. So I apologize for being Gabby, but thank you for the opportunity to catch up and talk about this stuff. I have a passion for it, and I really do love what I do, so I'm really lucky to be in that kind of a situation.

Well, your passion is clear, and no need to apologize.

I think we need to do a part two, and I think your final comments are appropriately optimistic and inspiring for us to close on today. So, Jeff, this has been a pleasure, and let's think about a part two, okay? That sounds great, Sue. Thanks. All right, take care. Bye bye.

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